Thursday, May 20, 2010

Idiopathic Toe Walking and Botox

The Journal of Children's Orthopaedics has published research on the use of Botox A in children with idiopathic toe walking. Fifteen children (ages 5-13)with a diagnosis of idiopathic toe walking underwent a gait analysis followed by Botox in the calf muscles and an exercise program. Gait analysis was repeated at 3 weeks, 3 months, 6 months and 12 months after treatment. Results from the gait analysis indicated significant improvements in decreased plantar flexion angle at initial contact and during swing phase and increased dorsiflexion during midstance. At 12 months post treatment, parents reported that 3 of the 11 children stopped toe walking completely, 4/11 decreased toe walking, and 4/11 continued to toe walk. The researchers concluded that Botox and exercise treatment for idiopathic toe walking displays gait pattern changes but does not always stop toe walking.

4 comments:

Idiopathic toe-walking runs in my family so this is of personal interest to me. I have no problem with a trial of Botox for ITW with 1/3 absolute response and 2/3 good response in a small trial - primarily because Botox is proven as safe and mostly effective for changing muscle function in other etiologies.

At the same time, I can't say I would choose Botox for a family member. I think AFOs and stretching would likely produce similar results. And exercise. I.like.exercise. ;)

As a physical therapist with a child with ITW I have researched many treatments for this condition. My son is currently in AFO and does daily stretching, exercises and functional retraining. The AFO have help but they have also increased his tendency to pronate and externally rotate. He can correct with verbal cueing but it is difficult for him to maintain. After much reading I believe the next step for him his Botox and serial casting done over a 2 week period to achieve approximately 10 degrees of DF. A Canadian study was done with 11 kids with this treatment and showed improved results over Botox alone. Just more info for anyone interested.

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These pages are not intended to provide medical advice or physician/therapist instruction. Information provided should not be used for diagnostic or training purposes. Consult a therapist or physician regarding specific diagnoses or medical advice.